Menstruation is a natural, normal biological process experienced by all adolescent girls and women, yet it is not spoken about openly causing unnecessary embarrassment and shame. India’s 113 million adolescent girls are particularly vulnerable at the onset of menarche. At this time they need a safe environment that offers protection and guidance to ensure their basic health, well-being and educational opportunity is realised. Lack of a separate and usable girl’s toilet in schools and a toilet at home leaves adolescent girls and women to face the indignity of open defecation. However, safe and effective menstrual hygiene management, or ‘MHM’ is a trigger for better and stronger development for adolescent girls and women.
Menstrual hygiene management is an integral part of the Swachh Bharat Mission Guidelines (SBM-G). The Menstrual Hygiene Management Guideline is issued by the Ministry of Drinking Water and Sanitation to support all adolescent girls and women. It outlines what needs to be done by state governments, district administrations, engineers and technical experts in line departments; and school head teachers and teachers.
In considering the specific sanitation and hygiene requirements of adolescent girls and women, state governments and district administrations have a responsibility for putting in place the following. The framework highlights the essential elements of a menstrual hygiene management programme that should be integrated in to other government schemes.
In addition to making sure that every household has a toilet, governments and all stakeholders must make sure that,
It is important to understand what menstruation is, and how simple management interventions along with positive attitudes can make a lasting difference to the lives of every adolescent girl and woman. The following definitions are helpful.
|Adolescent girls||Adolescence describes the transitional period between childhood and adulthood. Girls aged 10 to 19 are adolescents.|
|Menarche||The first occurrence of menstruation|
|Menopause||The time in a woman’s life when her menstrual periods stop and she is no longer
able to have children
|A biological process in a woman where each month blood and other material is
discharged from the lining of the uterus. Menstruation occurs from the onset of
puberty until the menopause, except during pregnancy.
|Menstrual Hygiene Management (MHM); menstrual hygiene||The (i) articulation, awareness, information and confidence to manage menstruation with safety and dignity using safe hygienic materials together with
(ii) adequate water and agents and spaces for washing and bathing with soap
(iii) disposal of used menstrual absorbents with privacy and dignity
|Menstrual absorbent||A sanitary cloth, napkin, towel or pad is an absorbent item worn by an adolescent girl or woman when she is menstruating, or directly after birth while she is bleeding. The material absorbs the flow of blood from her vagina|
|Menstrual waste||Includes a used sanitary cloth, napkin, towel or pad that contains blood|
|A substance or object that is capable of being decomposed by bacteria or other living organisms and thereby avoiding pollution|
Menstruation is still a taboo in India and it is common for people across society to feel uncomfortable about the subject. To ensure that adolescent girls and women have the necessary support and facilities, it is important that the wider society, communities and families must challenge the status quo and break the silence around menstruation. It is therefore the responsibility of those with influence – including government officials and teachers, to find appropriate ways to talk about the issue and take necessary action.
While only adolescent girls and women menstruate, everyone in society needs to have a basic understanding of it. For example,
Schools and communities
|1||Training of Anganwadi
supervisors and workers
|Training of Nodal teachers for providing support to girls and boys on puberty related
issues; and support to girls with regards to Menstrual Hygiene Management in schools and Kasturba Gandhi Balika Vidyalayas
|Rashtriya Kishor Swasthya Karyakram & Adolescent
Reproductive Sexual Health:Counseling of adolescent girls on puberty and Menstrual Hygiene Management
|Training of teachers and residential staff in Ashram schools and madarasas||Access to absorbents via
Self Help Groups under the fold of National Rural
|2||MAVIM: Access to absorbents via Self Help Groups; production of Sanitary Napkins at the village level by Self Help
Group run units; marketing
and demand generation of
|Access to absorbents at the school level and teaching to make absorbents for self-use in schools and Kasturba Gandhi Balika Vidyalayas||Water, Sanitation and Hygiene related facilities supporting Menstrual Hygiene Management||Educational sessions with school going girls and boys by the medical teams of Rashtriya Bal Swasthya Karyakram visiting the schools||Menstrual Hygiene
|Production of Sanitary Napkins at the village level
by Self Help Group run unit;
marketing and demand generation of Sanitary
|3||Reaching out to out of school girls through SABLA, Integrated Child Development Services, Self Help Groups under Mahila Arthik Vikas Mahamandal||Water, Sanitation and Hygiene related facilities supporting Menstrual Hygiene Management||Provision of disposal
|The Adolescent Girls Anaemia Control Programme:
Counselling and support to adolescent girls on how to improve their diets; weekly iron and folic acid supplementation for out of school girls through Integrated Child Development Services and school girls within educational institutions
|Regular supply of sanitary napkins||Menstrual Hygiene
among women and mothers to be oriented; Water, Sanitation and Hygiene as part of the agenda of the Self Help Groups and Voluntary Organizations under National Rural Livelihoods Mission
|Shelter Homes: Menstrual Hygiene Management
promotional activities and
supply of sanitary napkins;
established; trained staff;
Water, Sanitation and Hygiene related facilities
supporting Menstrual Hygiene Management
School Management Committee sensitized to enable gender sensitive decisions supporting coping of girls to puberty and menstruation; reaching out to fathers and sensitizing them on Menstrual Hygiene Management so they can besupportive and make appropriate decisions
|Provision of funding for IEC
|Menstrual Hygiene Scheme: Menstrual Hygiene Management promotional activities in the community;
distribution and supply of sanitary napkins; disposal
training of ASHA
|Adolescent Resource Centers (ARCs): Counseling of
adolescent girls on puberty and Menstrual Hygiene
|MRMs Trained on Menstrual Hygiene Management and act as peers to promote
menstrual hygiene practices and management
|Water,Sanitation and Hygiene related facilities supporting Menstrual Hygiene Management|
Convergence and coordination with different ministries, departments and schemes
Printed and verbal information about menstruation and menstrual hygiene management is crucial for girls Without it the majority face adolescence with no prior knowledge of what is happening to their bodies and why. Working with girls will assist them to feel more confident about managing their menstruation privately and effectively in school and at home Teachers should take in to account the learning needs of different girls and treat the needs of each sensitively. While working with girls it will be important to understand the number of menstruating girls and the number of girls reaching menarche. Separate sessions can be taken with girls in both categories. However, the girls who are menstruating will need a lot more support. It is also advised to build a trust and rapport over time and to repeat sessions regularly so that girls feel comfortable to talk about menstruation.
Informed adolescent boys, male teachers and parents contribute to a supportive environment for adolescent girls in school and at home. Working with boys also helps to ensure that girls are free from ridicule and treated with respect and dignity throughout their school life and beyond. This will include:
The establishment of support groups, such as the Girls Hygiene Clubs, perhaps linked to the child cabinets is an essential part of ensuring peer-to-peer learning and sharing of information. Such groups work well when girls are in charge, take responsibility, provide peer advice and represent girls’ views at school meetings. In the same manner, support groups among girls out of school can be created and the girls to be engaged in the process as described above. Toilet cleaning should not be a duty assigned to such clubs.
Managing menstruation in a hygienic way involves not only access to basic sanitation facilities, soap and water but also to so-called menstrual absorbents. Every adolescent girl and woman should use menstrual absorbents based on informed choice. Indian adolescent girls and women use different menstrual absorbents, not all of which are ‘hygienic’, however no girl should face ridicule or shame in this situation. Rather efforts should be made to increase access to hygienic options.
Menstrual absorbents: advantages and disadvantages
Note : It does not include tampons and menstrual cups, as they are not commonly available or used in India.
Adapted from: Source: Mahon, T., Cavill.S & House, S (2012) “Menstrual hygiene matters, a resource for improving menstrual hygiene around the world” WaterAid.
|Natural materials (e.g. mud, cow dung, leaves)
||Free, locally available||High risk of contamination; negative health impact; difficult and uncomfortable to use; less absorbent|
|Newspaper, plastic bags|
|Strips of sari, towel, bed
sheets, or other types
|Easily available, washable;
|Requires laundering in a private space
with a water supply and soap and a sun-lit place to dry and air the cloths; odour risk if reused without adequate laundering;
chaffing if used while dam
|Tissue, toilet paper||Easily available in the local market; average absorption||Loses strength when wet and can fall
apart; difficult to hold in place
|Cotton wool||Good absorption properties;
easily available locally
|Difficult to hold in place; an expensive
|Locally made reusable
|Can be used for 6-12 cycles; more
cost-effective than disposable options; income generation opportunity; Environment-friendly as degrade on disposal
|Not always absorbent enough or the correct shape; requires adequate laundering in a private space with a water supply and soap and a sun-lit place to dry and air the cloths|
|Can be used for up to 12 cycles; cost-effective, yet more expensive than locally made; environment-friendly compared to disposable napkins; a high standard and hygienic product quality||Costs may be prohibitive to potential users; requires adequate laundering in a private space with a water supply and soap and a sun-lit place to dry and air the cloths; not widely available|
|Often available, except in remote
locations; range of sizes and types
available in some locations; Well-designed through research and development
|Costs are prohibitive to many potential
users; generate a lot of waste and not
environment-friendly; Need to assure
The choice and preference for an option depends on individual preference, price, availability in the local market and convenience. Simple, clear and factually correct information helps girls to decide which menstrual absorbent to use, free from judgement by others.
Every school is required to have basic water and sanitation infrastructure so that girls and female staff can privately manage menstruation hygienically and with dignity. Essential facilities are:
Beyond the provision, infrastructure should be operated and maintained properly. These toilets for girls have to be so designed that they can be easily used by girls with physical disabilities.
Water and soap in every school is essential. Both are needed for girls, boys, and staff to wash hands with soap after toilet use and before eating food. Girls and female staff must have clean, easily accessible water and soap to wash them, wash their clothing if soiled, and wash menstrual cloths or reusable napkins. Water must be inside the toilet, ideally either via a tap or a dedicated container in each cubicle. A mug should be provided to allow girls to dispense water for their own personal cleaning and to clean the toilet if required.
Every person in the school community regardless of gender or caste should have access to a clean and well-maintained toilet. Adolescent girls and female teachers have special sanitation requirements.
It is important to consider safe menstrual hygiene disposal options and ensure that girls and female teachers know how to use them. Common practices range from unsafe to safe, with unsafe disposal being unacceptable.
PHED/RD engineers can provide guidance on assessing different safe disposal options and ensure proper planning, design, budgeting and operation and maintenance thereof. Consultation with girls' and their endorsement on the practical aspects is important to ensure use. For example, locating the disposal point near the girls' changing area, and ensuring the facility is out of sight to boys.
Disposal bins are a good and affordable collection option. These must be placed within the toilet, or very close by it, ideally provided for each cubicle. Bins must be washable and must have close fitting lids to minimise seepage of odour or waste before mass disposal. Depending on the type and location of the final disposal, there might be a need for an emptying schedule of individual bins, and transport to the disposal site. It is recommended to designate a point person of the school staff to be responsible and accountable for this. To avoid transport, some incinerators have been built in with chutes directly adjacent to toilet building.
Safe disposal means ensuring that the process of destruction of used and soiled materials is done without human contact and with minimal environmental pollution. Unsafe disposal-throwing used cloth into ponds,rivers, or in the fields exposes others in the area to decaying material and should be avoided. Offsite disposal can be organized with the communal or town solid waste collection and management system. If a hospital with a safe and treatment unit for hazardous waste is nearby, this might be a best solution to explore. However, this is unfortunately not a viable option for many rural schools, and transport will be a logistical and financial challenge. Options for on-site disposal includes disposal deep burial, composting, pit burning and incineration. The right option depends on key factors such as amount and type of materials, the available budget (investment and O&M costs) and environmental considerations. The following table shows the recommendations for different types of material and disposal options.
|Material||Disposal into pit latrine||Deep burial||Composting||Pit burning||Incinerator|
|Used tissues, paper,
|Cotton napkins (reusable or commercial)||Less
with plastic and liners
with good incinerator
In addition to these factors, socio-cultural perceptions might play a role in choice and use of the solution. In some areas of India there is resistance to burning through incinerators, yet a burning pit may be more acceptable. There might be also the false perception that disposing of their menstrual management products in pit latrines prevents from being used in witchcraft.
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